Business Process Services

Minimize Denials and Improve Patient Payment Collections for Enhanced Revenue Cycle Performance

9 October 2023

denial management in healthcare for Enhanced Revenue Cycle Performance

Well-organized revenue cycle management is a cornerstone of success for healthcare providers in the United States. In an era where the healthcare landscape continually evolves, providers face many challenges. Among these challenges, one stands out prominently—minimizing claims denials and enhancing patient payment collections. This blog underscores the importance of these practices and how they can impact a healthcare provider’s financial health.

According to the “National Hospital Flash Report: April 2023″ by Erik Swanson, published by Kaufman Hall on May 3, 2023, healthcare providers in the US are grappling with an increasing number of claims denials. This issue not only affects the financial stability of healthcare organizations but also impacts patient care and satisfaction. To address these challenges, healthcare providers must proactively streamline their revenue cycle management (RCM) processes.

Understanding the Denials Dilemma

Denials are more than just rejected claims; they represent missed revenue opportunities and can significantly impact the bottom line. The “Market Insights Study” conducted by Eliciting Insights revealed that hospitals are experiencing an average claims denial rate of 15%. This translates to substantial revenue leakage that can no longer be ignored.

To overcome this hurdle, healthcare providers must identify the root causes of denials. According to the MGMA’s “6 keys to addressing denials in your medical practice’s revenue cycle” from March 18, 2021, common reasons for denials include incomplete or inaccurate patient information, coding errors, and insufficient documentation. Healthcare organizations can significantly reduce denial rates and improve their revenue cycle performance by addressing these issues.

The Financial Impact of Denials

Claim denials are not just a minor inconvenience; they profoundly impact a healthcare organization’s financial health. In a report published by Becker’s Hospital CFO Report on January 23, 2023, Andrew Cass highlighted “13 top reasons for claims denials,” including issues related to coordination of benefits, medical necessity, and timely filing. These denials can lead to delayed payments and increased administrative costs as healthcare providers invest time and resources in appeals and resubmissions.

Moreover, Change Healthcare’s analysis in 2017, titled “An Estimated $262 Billion in Healthcare Claims Initially Denied in 2016,” underscores the scale of the problem. Denied claims amount to billions of dollars lost each year, putting a significant strain on healthcare organizations’ revenue streams.

Streamlining Patient Payment Collections

To address the challenges of patient payment collections, healthcare providers need efficient and patient-friendly solutions. Healthcare providers must adapt to change and design strategies that facilitate efficient patient payment collections.

One key strategy, as noted in “How Payment Plans Could Cure A $7.5B Medical Malady” by PYMNTS on January 15, 2019, is the implementation of flexible payment plans. These plans allow patients to manage their healthcare expenses by breaking them into manageable installments. By offering this option, healthcare organizations accommodate patients’ varying financial situations and increase the likelihood of timely and complete payments.

Additionally, integrating technology and digital payment solutions has proven to be a game-changer in healthcare revenue cycle management. Healthcare providers can simplify the payment process when patients use online payment options. Patients can conveniently settle their bills, view their payment history, and even set up automatic payments. This enhances the patient experience and significantly boosts the chances of collecting payments promptly.

Leveraging data analytics is another way healthcare providers gain insights into patient payment behavior. Providers can tailor their collection strategies, send targeted reminders, and optimize payment plans by understanding patterns and trends. This data-driven approach streamlines payment collections and fosters transparency and trust between patients and healthcare organizations.

Partnering with PreludeSys for Optimal RCM

As healthcare providers seek to minimize denials and improve patient payment collections, finding the right revenue cycle management partner is crucial. PreludeSys is exceptionally well suited for this role.

PreludeSys offers cutting-edge Revenue Cycle Management (RCM) solutions tailored to the unique needs of healthcare providers. With a deep understanding of the challenges faced by the healthcare industry, PreludeSys provides a comprehensive suite of services designed to optimize revenue cycle performance.

By leveraging PreludeSys’ expertise and innovative technology solutions, healthcare providers can reduce denials, streamline patient payment collections, and enhance their financial stability. It’s time to take a proactive approach to revenue cycle management and secure a brighter financial future for healthcare providers and their patients. With the ever-increasing complexity of RCM, having a reliable partner like PreludeSys can make all the difference in achieving optimal revenue cycle performance.

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